Provider Demographics
NPI:1013772342
Name:BRANDL, MADELYN BRYAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:BRYAN
Last Name:BRANDL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8163
Mailing Address - Country:US
Mailing Address - Phone:318-376-5570
Mailing Address - Fax:
Practice Address - Street 1:200 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8163
Practice Address - Country:US
Practice Address - Phone:318-376-5570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202759163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse